What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease (n=1528425). Intervention: Cardiovascular disease (exposure) vs. Matched individuals without cardiovascular disease. Primary outcome: Lung cancer incidence (HR 1.67, 95% CI 1.42-1.96).

What does this research mean for the field?

Patients with cardiovascular disease have a 67% increased risk of lung cancer incidence and a 95% increased risk of lung cancer mortality compared to individuals without cardiovascular disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 5, 2022Open Access

Cardiovascular disease and risk of lung cancer incidence and mortality: A nationwide matched cohort study

Key Result

Patients with cardiovascular disease had a 67% increased risk of lung cancer incidence (HR 1.67) and a 95% increased risk of lung cancer mortality compared to matched individuals without cardiovascular disease.

Study Design

Type

Cohort (n=1,528,425)

Structured PICO

Does cardiovascular disease increase the risk of lung cancer incidence and mortality in the general population?

Population

1,528,425 individuals (306,285 patients with a first-time diagnosis of cardiovascular disease and 1,222,140 matched individuals without CVD), average age at CVD diagnosis 29.2±8.8 years, approximately 55% female. Excluded patients with CVD diagnosed before 10 years of age and those with lung cancer before CVD diagnosis.

Intervention

Diagnosis of cardiovascular disease (CVD), including heart disease, hypertensive disease, and vascular diseases

Comparator

Matched individuals without cardiovascular disease (matched 1:4 on sex and age)

Outcome

Lung cancer incidence and lung cancer mortalityhard clinical

A diagnosis of cardiovascular disease is associated with a significantly increased long-term risk of developing and dying from lung cancer, particularly when diagnosed in middle adulthood.

Main Result

Effect estimate: HR 1.67 (95% CI 1.42-1.96)

Absolute Event Rate: 0.08% vs 0.04%

Limitations

Possibility of residual confounding by uncontrolled factors, particularly lack of comprehensive smoking information
Potential misclassification bias for subjects born before 1977 who might have had a prior CVD event
Potential detection bias as CVD patients may have more frequent doctor visits
Maximum CVD diagnosis age was 52 years old, limiting generalizability to older populations
Broad definitions of heart disease and vascular disease subtypes

Abstract

Purpose Previous studies have suggested a link between cardiovascular disease (CVD) and the subsequent development of lung cancer. However, empirical evidence on the association of CVDs, particularly type-specific CVDs, with lung cancer incidence and survival remains limited. Methods The cohort study included 306,285 patients with CVD and 1,222,140 individuals without CVD. We performed stratified Cox regression to estimate the hazard ratio (HR). Results During up to 42 years of follow-up, 243 (0.08%) and 537 (0.04%) participants were diagnosed with lung cancer among CVD patients and matched individuals, respectively. Patients with CVD had a 67% increased risk of lung cancer (HR: 1.67, 95% confidence interval CI: 1.42–1.96). The increased risks were observed in patients with heart disease (1.93, 1.30–2.85), vascular disease (1.88, 1.35–2.61), and hypertensive disease (1.46, 1.15–1.85), respectively. Patients with CVD had a 95% increased risk of lung cancer mortality (1.95, 1.50–2.55), particularly vascular disease (3.24, 1.74–6.02) and heart disease (2.29, 1.23–4.26). Patients with CVD diagnosed in middle adulthood (40 years old) tended to have a higher incidence risk (3.44, 2.28–5.19) and mortality (3.67, 1.80–7.46) than those diagnosed at younger ages. Conclusions Our findings on the association of CVD diagnosis, especially heart and vascular disease, with increased risk of lung cancer incidence and mortality suggest that CVD contributes to the development and worsening of lung cancer survival. In particular, people with CVD diagnosed in middle adulthood (40 years old) would benefit from early preventive evaluation and screening for lung cancer.

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